Resources

Client Alerts, News Articles, Blog Posts, & Multimedia

Everything you need to know about BMD and the industry.

Ohio House Passes Bill 388 Including Out-of-Network Reimbursement Requirements

Client Alert
July 6, 2020

On May 20, 2020, the Ohio House of Representatives unanimously passed House Bill 388, which would enact five new Ohio Revised Code sections regarding out-of-network care and reimbursement. Sponsored by Representative Adam Holes – District 97 – House Bill 388 would require a health plan issuer to reimburse the following: 

  • An out-of-network provider for unanticipated out-of-network care provided at an in-network facility. 
  • An out-of-network provider or emergency facility for emergency services provided at an out-of-network emergency facility. 
  • An out-of-network ambulance for emergency services provided in an out-of-network ambulance. 
  • An out-of-network provider or facility for clinical laboratory services provided in connection with unanticipated out-of-network care or emergency services. 

As used above, "unanticipated out-of-network care" means health care services, including clinical laboratory services, that are covered under a health benefit plan and that are provided by an out-of-network provider when either of the following conditions applies: (1) the covered person did not have the ability to request such services from an in-network provider; or (2) the services provided were emergency services.

In addition to the above requirements, House Bill 388 also sets forth the following: 

  • Prohibits a provider, facility, emergency facility, or ambulance from balance billing a patient for unanticipated or emergency care when that care is provided in Ohio. 
  • Provides that a covered person’s cost-sharing responsibility for the services described above cannot be greater than if the services were provided in network. 
  • Establishes the default reimbursement rate as the greatest of the in-network rate, the out-of-network rate, or the Medicare rate and establishes procedures by which payees (providers, facilities, emergency facilities, and ambulances) may seek to negotiate the reimbursement in lieu of the default reimbursement rate. 
  • Permits certain payees to seek arbitration if negotiation is unsuccessful, and establishes criteria to be eligible for arbitration, and establishes procedures for the conduct of the arbitration. (Requires the Superintendent of Insurance to select an arbitration entity to conduct arbitrations under the bill using specified criteria). 
  • Requires a provider to disclose certain information to patients regarding the cost of out-of-network services that are not unanticipated out-of-network care or emergency services. 

The requirements found in House Bill 388 would be effective nine months following the bill’s effective date. Any payee or issuer in violation of these requirements would face disciplinary actions and/or penalties. The bill now continues the rule making path and will be debated and voted on by the Ohio Senate.

Please contact a BMD healthcare attorney if you have any questions regarding House Bill 388, any other reimbursement question, or other general healthcare questions.

Ohio House of RepresentativesHouse Bill 388out of networkout of network careout of network reimbursementprovidershealthcare providershealthcarephysiciansBMD Healthcare & Hospital Law GroupKevin Cripe
Client Alert

UPDATE: COVID-19 Considerations for the Construction Industry

March 26, 2020The implications of COVID-19 for the construction industry are significant and rapidly evolving, since Governor Mike DeWine instructed Ohioans to “stay at home” via Order (the “Order”) effective March 23, 2020.Client Alert

FFCRA Update: Implementation Date Accelerated from April 2 to April 1

March 26, 2020The Families First Coronavirus Response Act (FFCRA) was signed into law on March 18, 2020, and provides several responses to address the ongoing coronavirus pandemic, including providing for free coronavirus testing, giving a boost to funding for state unemployment compensation (subject to states waiving work search requirements and the waiting week), and leave for employees affected by coronavirus through the Emergency Family and Medical Leave Expansion Act and the Emergency Paid Sick Leave Act. The FFCRA also provides refundable tax credits for employers providing the required paid family and sick leave to employees in connection with this public health emergency.Client Alert

FFCRA & Payroll Tax Credit: How Does it Work?

March 26, 2020The Families First Coronavirus Response Act (“FFCRA”) provides for refundable payroll tax credits for employers in order to assist with the cost of providing Coronavirus-related leave to their employees. These refundable payroll tax credits are designed to reimburse small and midsize employers for the cost of providing COVID-19-related leave to their employees. This tax credit goes into effect on April 1, 2020 and will remain in effect until December 31, 2020 unless extended or modified.Client Alert

Florida HB 607 - APRNs Can Now Admit, Care, Discharge Patients without Physician Oversight

March 25, 2020On March 11, 2020, lawmakers in both chambers of the Florida legislature passed House Bill 607 — legislation which would allow advanced practice registered nurses, or APRNs, to single-handedly admit, care for, and discharge patients from medical facilities. This would effectively eliminate the need for physician oversight, a costly expense for independent nurse practitioners.Client Alert

Ohio Permitting Deferral of Health Care Premiums for Employer Plans

March 25, 2020Effective March 20, 2020 and continuing through the expiration of the state of emergency declared by Governor DeWine on March 9, 2020, the Ohio Department of Insurance is requiring all health insurance companies operating in Ohio to give their insureds the option of deferring premium payments coming due, interest free, for up to 60 calendar days from each original premium due date. See Department of Insurance Bulletin 2020-03.
Older posts
Newer posts